Provider Demographics
NPI:1366755415
Name:VANG, STEPHEN D (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:VANG
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:166 19TH ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4654
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:166 19TH ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4654
Practice Address - Country:US
Practice Address - Phone:320-230-7788
Practice Address - Fax:320-230-7789
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10857363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical